In the Netherlands, all rejected asylum seekers and undocumented migrants are entitled to ‘medically necessary care’, defined as ‘well-considered and appropriate medical care’, to be indicated by doctors.186 However, this fund, coordinated by Zorginstituut Nederland,187 only compensates care which is covered by the most basic health care insurance scheme. As a result physical therapy and also dental care for adults is not covered in the fund, which leads to severe access problems in practice. Besides, this medically necessary care is only accessible if both the migrant and the health care provider are aware of the possibility to declare costs, which is not always the case.188

Moreover still problems concerning the access to medication189 (a personal contribution of €5,=, which in some cases, but not always, is covered by local funds).

and transfer of medical data between different settings undocumented migrants find themselves in (detention, temporary shelters, street) is not well organized and needs improvement to support health professionals in their work regarding undocumented migrants.190 In 2015 various recommendations were presented at the Minister of Health191, on the fact that information about care to undocumented is not sufficiently accessible for both health professionals and undocumented migrants. The state leans too much on the (often invisible) efforts of Ngo’s and support organizations, to provide health professionals with adequate information.

The right to health of undocumented persons with medical needs is further threatened and undermined by the fact that they are not provided with adequate day- and night shelter, rendering medical care ineffective.192

Recommendation 40:

The submitting parties recommend the Committee to ask the Dutch government to improve accessibility to health care for undocumented migrants by, e.g.:

to implement a national monitoring system with regard to access to healthcare for undocumented migrants in various settings,

to ensure that health professionals are adequately informed about the possibilities in ‘care to undocumented’ and initiate an entity to coordinate the mediation of access to healthcare between migrants and regular healthcare,

to ensure adequate (night and day) shelter for vulnerable and ill persons in order to protect their right to health.

Right To Health of Undocumented People And Asylum Seekers In Detention Centres

Deprivation of freedom is a particularly severe measure. To give substance to the principle of last resort, it is of great importance to propose alternatives to detention. It is well known that the administrative detention of undocumented migrants and asylum seekers forms a serious risk for their mental health.193 This certainly applies to persons in a vulnerable situation.194 They are disproportionally more at risk of worsening health conditions while in detention. Still, too many persons in a vulnerable situation are placed in immigration detention. In the proposed bill: ‘Law on return and immigration detention’195 no categories of vulnerable people, like children, pregnant women, the elderly and persons with physical and/or psychological problems, will be excluded a priori from custody.

The submitting parties observe that health and well-being of people who are detained for several months, deteriorates.196 In 2015 480 people were confined for 3 to 6 months and 140 people 6 months and longer. These detentions include far going control measures like punitive isolation measures and handcuffing people when they have for instance appointments in the hospital. It also includes confinement in cells during several hours during a 24-hours period, the lack of meaningful daily activities, of freedom of movement, of possibilities to easily maintain external contacts, directly or through internet and email, and lack of privacy.197 Expectations that the proposed bill would improve the regime, are not met.198 Usually detention aggravates physical and mental problems of vulnerable persons. This is especially true for those migrants who are traumatized by experiences of violence in their home-country or because they are victims of trafficking.199

Despite previous statements of the Ministry of Security and Justice to limit the duration of immigration detention to a minimum,200 a significant number of persons confined in immigration detention centres were put in solitary confinement as a measure of good order and security, and in particular on medical grounds as recent as 2015. In 2014 medical grounds included mainly threats or attempts of suicide, confused behaviour or hunger and/or thirst strike.201 There are no medical grounds for isolating hunger or thirst strikers. Moreover, the care given by making use of isolation cells does not seem to be equivalent to the care given in mental health care institutions where since 2006 the aim is to abolish solitary confinement.202 Isolation of people with suicidal ideation or other mental health problems, as well as people on hunger- or a thirst strike, may have an adverse effect.203

Recommendation 41:

The submitting parties recommend the Committee to urge the Dutch government to:

ensure in legislation that persons in a vulnerable situation, such as pregnant women, the elderly, children and persons with serious physical and/or psychiatric problems cannot be confined in immigration detention;

ensure that the conditions of administrative detention do not negatively contribute to the (mental) health status of persons detained;

take concrete steps to work on the reduction and eventual elimination of the use of isolation as an order measure and to put an end to the isolation of persons on a hunger and or thirst strike.